Pasha SF1, Pennazio M2, Rondonotti E3, Wolf D4, Buras MR5, Albert JG6, Cohen SA7, Cotter J8, D'Haens G9, Eliakim R10, Rubin DT11, Leighton JA1.
1 - Mayo Clinic Arizona, Scottsdale, Arizona, USA.
2 - Division of Gastroenterology U, San Giovanni AS University-Teaching Hospital, Torino, Italy.
3 - Gastroenterolgy Unit, Ospedale Valduce, Como, Italy.
4 - Atlanta Gastroenterology Associates, Atlanta, Georgia, USA.
5 - Division of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
6 - Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
7 - Children's Center for Digestive Health Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
8 - Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
9 - Amsterdam University Medical Center, Amsterdam, the Netherlands.
10 - Sheba Medical Center, Tel Aviv, Israel.
11 – The University of Chicago Medicine, Chicago, Illinois, USA.
BACKGROUND: The main factor that limits wider utilization of capsule endoscopy (CE) in Crohn's disease (CD) is the potential risk of retention. The aim of this systematic review was to evaluate capsule retention rates in adult and pediatric CD and determine if retention risk is reduced in established CD (ECD) with patency capsule (PC) or magnetic resonance/computed tomography (MR/CT) enterography.
METHODS: Studies of CD patients undergoing CE that reported retention were identified. Pooled estimates for retention rates and relative risk in ECD to suspected CD (SCD) were calculated. All hypothesis tests were 2-sided; statistical significance was set at a P value of <0.05.
RESULTS: In the overall CD cohort, retention rates were 3.32% (95% confidence interval [CI], 2.62%-4.2%): 4.63% (95% CI, 3.42%-6.25%) and 2.35% (95% CI, 1.31%-4.19%) in ECD and SCD, respectively. Retention rates were 3.49% (95% CI, 2.73%-4.46%) and 1.64% (95% CI, 0.68%-3.89%) in adult and pediatric CD, respectively. Retention risk in adult ECD was 3.4 times higher than SCD, but there was no difference in retention risk in pediatric ECD compared with SCD. Retention rates in ECD were decreased after patency capsule (2.88%; 95% CI, 1.74%-4.74%) and MR/CT enterography (2.32%; 95% CI, 0.87%-6.03%).
CONCLUSIONS: In comparison with older literature, this meta-analysis demonstrates lower CE retention rates in SCD and ECD. Retention rates in pediatric CD were lower than in adult CD. Retention rates in adult ECD were higher than SCD, but there were no differences between pediatric ECD and SCD. Retention rates in ECD were lower after negative PC or MR/CT enterography.